AIDS Care Gap between Wealthy and Developing Countries Risks Becoming a Chasm

AIDS leaders gathering in London today face the daunting challenge of
implementing new World Health Organization (WHO) recommendations for
earlier treatment with better AIDS drug cocktails at a time when donors
are backing away from the promise of "universal access," said Doctors
Without Borders/Medecins Sans Frontieres (MSF).

The WHO recently released new treatment recommendations for people
living with HIV in developing countries which could help bridge the
significant gap between the standard of care for people in northern and
southern countries.

"In MSF programs we are striving to meet the higher standard of care
which means starting patients on antiretroviral drugs earlier, which
gives them a better chance of long-term survival," said Ariane
Bauernfeind, program manager at MSF in Brussels. "I look forward to the
day when I no longer have to see patients experiencing the painful and
debilitating side effects of the drug stavudine (d4t). WHO recommends
replacing stavudine with other drugs. However, we see ministries of
health hesitating to make these changes because of a withdrawal of
donor commitments."

Lesotho, the poorest among the countries most affected by HIV, has
already updated its national protocols in 2008 recognizing the clinical
and financial benefits of improved care. MSF is working with the
Ministry of Health in rural areas to provide the optimal package of
HIV/AIDS treatment, including an early start on a tenofovir-based
regimen.

Changing towards the improved WHO guidelines will cost more in the
short term, but long term it is necessary for ensuring better survival
and greater control of the epidemic.

"If WHO's new recommendations are not implemented, the international
community risks subsidizing less expensive yet sub-standard care for
developing countries," said Sharonann Lynch, MSF's HIV/AIDS policy
advisor. "Avoiding this will depend on the willingness of donors to
make new commitments. Although this is not easy in today's financial
environment, donor countries cannot back away from supporting the
promise of universal access to treatment made five years ago."

In 2005 the G8 committed to supporting AIDS treatment for everyone
who needed it by 2010. But today WHO estimates that only four of 14
million people needing AIDS treatment have access to it. Many African
countries facing crushing epidemics depend on external funding to
sustain and scale up HIV treatment programs. But the commitment of
funders is waning. The United States President's Emergency Plan for
AIDS Relief (PEPFAR) has kept funding flat over the past few years and
scaled back financial commitment for treatment slots in some countries.
Shifting donor priorities have also rendered uncertain the future
support from the Global Fund to Fight HIV/AIDS, TB and Malaria. The
Global Fund which has thus far paid for two thirds of the people who
are currently receiving HIV/AIDS treatment needs to raise at least
US$20 billion for the next three years of programs.

Because of this funding retreat, some facilities are facing the
stark reality of rationed treatment slots and need to turn away
patients from clinics.

As an emergency medical humanitarian organization, MSF has provided
life-saving HIV/AIDS treatment for over 140,000 people in over 30
countries.